How Can I get Beyond the Basics of Hospital Readmission and Become a Preferred Provider? Kim Barrows RN BSN Session Objectives At the end of the session the learner will be able to: 1. Discuss the history of hospital readmission and its impact on the industry. 2. Discuss and analyze the types of data necessary to appropriately measure hospital readmission rates. 3. Describe potential solutions within your facility that will positively affect clinical outcomes. 4. Describe how progress is measured after implementation. 5. Discuss measures to ensure continuous quality improvement. 1
The Affordable Care Act This Act has brought about many challenges but at the same time it has opened opportunities for Skilled Nursing Facilities to set themselves apart from their competitors. Why The Focus The Patient Protection and Affordable Care Act (March 23, 2010) has several provisions to reduce hospital readmissions Medicare is offering financial incentives to reduce potentially avoidable hospital transfers through pay-for-performance, bundled payments, ACOs and other strategies CMS implemented financial penalties for hospitals with high 30 day readmission rates for the following diagnoses: CHF, Pneumonia, Acute Myocardial Infarction, COPD and elective Hip & Knee Replacements. 2
What is an ACO? Groups of volunteer doctors, hospitals, nurses and other care providers who offer coordinated quality care to a specific population of patients. ACO Models in Ohio http://innovation.cms.gov/initiatives/map/index.ht ml?statepass=oh 3
Bundled Payments Bundled Payments http://innovation.cms.gov/initiatives/map/index.html?statepass=oh 4
Readmission Penalties by Hospital *Provided by Kaiser Health News; http://capsules.kaiserhealthnews.org/wpcontent/uploads/2014/10/readmissions-year-3.pdf How Did Medicare Decide On Penalties? Policy developed by CMS endorsed by the National Quality Forum (NQF) for heart attack, heart failure and pneumonia Three years of discharge data and minimum of 25 cases for each condition were used to develop these ratios Adjustment for factors that are clinically relevant including patient demographic characteristics, co-morbidities and patient frailty *Provided by Kaiser Health News; http://www.kaiserhealthnews.org 5
30 Day, All-Condition Medicare Readmission Rates http://www.academyhealth.org/files/2014/monday/brennan.pdf Post-Acute Care Reform SNF Readmission Penalties Oct 1 st 2016-CMS will share with you how you are performing as far as readmissions Oct 1 st 2017-Rates will be shared with the public on Nursing Home Compare Oct 1 st 2018-Rates will be cut 2%; based on your performance with readmissions you could get 98% of your rate or greater than 100% http://waysandmeans.gov/uploadedfiles/pac_reform_f act_sheet.pdf 6
Potential Complications with Hospital Admissions Transfer Trauma Delirium Immobility/Deconditioning Falls Weight Loss Incontinence and Foley Catheters Hospital Acquired Infections Wounds Polypharmacy Factors Influencing Hospital Readmissions Geography Liability & Regulatory Concerns Hospitalizations Demographics Patient/Family Requests Co-morbidities 7
Factors Influencing Higher Readmission Rates Unsatisfactory Discharge Planning Access to PCP Noncompliance Medication Errors Family/Caregiver Competency Clinical Condition Strategies for Success Decrease Unnecessary Readmissions Communication & Collaboration Resident/Family Satisfaction Success Preferred Provider Advanced Directives Quality Care 8
Advanced Data Collection Analysis Tracking Log Tracking Log Considerations Physician/Staff Discharging Time of discharge Discharges Education Advanced Directives Palliative Care/Hospice Interact Tools 9
Tracking Log Considerations Percentage of residents that are readmitted within the first 30 days for MI, Pneumonia or Heart Failure? Then include all diagnosis. Did we fully implement the cardiac program? Joint Replacement Program? Pulmonary Program? Who is referring to you? What type of residents are you admitting? Physician Tracking 10
How to Measure Rehospitalization Rates Based on claims (hospital & SNF Part A) Does not include ER visits and observation stays Excludes Medicare Advantage and private insurance %= numerator denominator %= # of persons sent to hospital # of persons admitted to SNF Brown University: http://ltcfocus.org/ SNF rehosp rates Great Emphasis On Quality Assuring and/or improving quality requires documenting valid metrics and proactively implementing & monitoring systems How are we being graded? CMS Five Star Report Nursing Home Compare Quality Measures Facility Satisfaction Survey QIS/Traditional Surveys State -Resident Satisfaction Survey State -Family Satisfaction Survey 11
TriHealth Metrics Metrics 12
Who s Watching Hospitals Survey Agencies ACOs MCOs Managed Care of America 13
Humana SNF Scorecard Provider demographics and Services Available Anthem Scorecard 14
Anthem-CareMore Becoming the Preferred Provider What is your niche or area of expertise? Pick one or two specialties Develop a unique program Market the outcomes. 15
Mission The mission is to improve the quality of care provided to our patients; by early identification, optimizing treatment and reducing preventable hospitalizations. Cardiac Cardiac Recovery Program 16
Standardized Patient Education Booklet Validated Competency Testing performed by Nursing and Therapy departments Resident Condition Meetings In-house Lab and Diagnostic Testing Utilize the Teach Back Method Early Warning Tool Cardiac Recovery Program Overview Care Coordinator Involvement Cardiac Approach ACLS Certification Education on Cardiac Disease and Management Techniques Pharmaceutical Management Therapists receive specialized cardiac training on the four classifications of the disease ACP equipment with measureable outcomes Psychosocial Management including Smoking Cessation Classes Nutritional Assessment and Counseling with a Registered Dietician 17
Cardiac Approach Wellness coaching on lifestyle changes Risk factor management (i.e. HTN, weight loss, lipids, etc.) Assist with developing a home exercise and therapy program Peer to Peer education Follow up call from the Care Coordinator after discharge Working hand in hand with home health agencies to provide the continuum of care and prevent readmission. Care Path: Symptoms of Congestive Heart Failure (CHF) http://www.interact2.net/tools.html 18
Resident Condition Meeting Functional Outcome Measurements Circulatory 19
SBAR Charting S= Situation B= Background A= Assessment Improves the quality of information that is communicated to the physician resulting in an accurate diagnosis and treatment. R= Recommendation http://interact2.net/docs/communication%20tools/sbar%20updated%20february%202011. pdf Evaluation of Resident s Knowledge Teach Back Method Medication Daily Weights Diet Evidenced based Clinical Tool that evaluates the resident s knowledge. 20
Stop & Watch Tool Guides frontline staff through brief review of early, often subtle indicators of change in condition Improves communication between frontline staff and the nurse in charge http://interact2.net/docs/communication%20tools/early_warning_tool _(StopWatch)c.pdf Electronic Medical Records Electronic Medical Records (EMRs) with complete, accurate and solid data. Software integration with partners to round out EMRs, e.g., labs, pharmacies, EKG reports, etc. Specialization programs that focus on reducing length-of-stay and improve the quality of care. Outcomes reports showing positive trends for lowering costs, boosting quality and reducing readmissions. 21
Telemedicine http://www.wlwt.com/news/christ-hospitalstudying-remote-monitoring-of-heartpatients/25516824 www.securetelehealth.com/telearticles-a-news.html Clinical Outcomes CHF Discharge Planning 22
CHF Program Outcome Orthopedic Programs YOUR RECOVERY The primary goal of your stay is for you to safely recover from surgery, participate in therapy, and to put you on the road to recovery. If there is anything we can do to enhance your stay and rehabilitation, please feel free to ask. Knee Replacement Hip Replacement 23
Joint Replacement Program Overview Standardized education booklet used through the continuum of care Staff education including competency testing Infection/pain monitoring Monitoring functional outcomes Decreased length of stay Patient/caregiver education Anticoagulant therapy Care coordinator involvement Outcome measurements Functional Outcomes Measurement Musculoskeletal 24
Joint Replacement Program Clinical Outcomes Ortho Program Outcomes 25
Educational Booklet Signs and symptoms of COPD exacerbation Pneumonia-when to call the physician Prevention Medication management Validated nursing and therapy competencies Outcome tracking Pulmonary rehabilitation Smoking cessation classes Care coordinator involvement Venous Blood Gas lab draw within facility with quick results 26
http://www.interact2.net/tools.html 27
Pulmonary Program Daily Checklist Functional Outcome Measurement Respiratory System 28
Clinical Outcomes COPD/Pneumonia Program Pulmonary Program Outcomes 29
Wound Program Wound specialist of Greater Cincinnati Dr. Arti Masturzo Mist Therapy Negative Pressure Therapy Lymphedema Treatment Comprehensive Wound Care Clinical Outcomes 30
Stroke Program The i-stat System An advanced handheld diagnostic tool that provides real-time, lab-quality results within minutes. Used for the Cardiac and Pulmonary Programs Comprehensive Point-of-Care Testing Diagnostic Testing (results ranging from 2 min to 17 min) Electrolytes and Hematology Blood Gas Chemistry Cardiac Markers Coagulation www.abbottpointofcare.com 31
(CORE) Readmission Risk Calculator www.readmissionscore.org/ Physician and NP/PA Expectations Required presence in facility Rounding with nursing staff Quarterly Meeting Involvement Offer education and In-Services for staff/families New admissions seen in a timely manner Available for family conferences Facility leadership involvement Supportive of programs to reduce readmissions 32
Care Coordinator Role Assist with discharge planning from the hospital to SNF to home Monitor the progression of the patient by ensuring program interventions are being followed If at any time the status of the patient is compromised for the first 30 days from hospital discharge, they will be urged to return to an HCMG facility to receive the necessary care unless it is lifethreatening. Symptom Management Nurse Practitioner Coordinate patient care with the Primary Care Physician and Interdisciplinary Team while in the SNF Continue coordinating care through the transition to home and thereafter First home visit 48-72 hours of discharge Clinical home data communicated to the Primary Care Physician Involve the patient and caregiver in standardized education Provide proactive medical management Coordinate and monitor medications from the SNF to home 33
Home Health Agency Follow up visits Medication reconciliation Compliance Standardized education Proactive medical management Standardized continuum of care How Often Home Health Patients had to be Admitted to the Hospital Unplanned Hospital Readmission Average (%) National Average 16% Ohio Average 16% Home Health Compare Website: http://www.medicare.gov/homehealthcompare/search.html# 34
All Cause/All Payer 30 Day Readmission Rate LTC Trend Tracker http://www.ahcancal.org/research_data/trendtracker/pag es/default.aspx 35
Becoming the Preferred Provider Design Unique Programs that are appealing to your local hospital and document outcomes for marketing. SNF provider Invest in staff training and education Invest in equipment Implement a system for calculating data Identify a champion within your organization to train, monitor and evaluate programs. Collect valid data which will allow you to present measureable outcomes. 36
Becoming the Preferred Provider Collaborate Monitor your readmission rates and be prepared to present yourself as a solution to the hospital s problem. Consider a Care Coordinator role within your organization and develop partnerships with like-minded companies to ensure a smooth transition of care. Bridging Connections Tri-health Hospitals Bethesda North Good Samaritan 37
Bridging Connections The Jewish Hospital Bridging Connections Mercy-Anderson Mercy-Fairfield Mercy-Clermont Mercy-West 38
Bridging Connections The Christ Hospital The first Accredited Heart Failure Network Centers of Advanced Quality Outcomes 39
Telemedicine for Heart Failure Management Marketing Points Improved medical care R/T early identification of change of conditions Capitalize on the program s uniqueness Better nursing assessment skills Better clinical outcomes Reduction in rehospitalizations Positive reputation among hospitals, MCOs and the community at large Improved Customer/Family Satisfaction 40
Questions Kim Barrows RN BSN kbarrows@hcmg.com 513-317-4421 41